Robert J. Glynn, PhD, ScD; Paul M Ridker, MD; Samuel Z. Goldhaber, MD; Julie E. Buring, ScD
Acknowledgments: The authors are indebted to the 39 876 participants in the Women's Health Study for their dedicated and conscientious collaboration and to the entire staff of the study. They also thank Roche Molecular Systems for providing the genotyping platform used in the study.
Grant Support: By the National Institutes of Health (grants HL71221, HL43851, and CA47988). Natural Source Vitamin E Association provided the vitamin E and vitamin E placebo, and Bayer HealthCare provided the aspirin and placebo aspirin.
Potential Financial Conflicts of Interest: Grants received: R.J. Glynn (Bristol-Myers Squibb). Honoraria: J.E. Buring (Bayer HealthCare). Other: J.E. Buring (Bayer HealthCare, Natural Source Vitamin E Association).
Requests for Single Reprints: Robert J. Glynn, PhD, ScD, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Glynn, Ridker, and Buring: Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA 02215.
Dr. Goldhaber: Division of Cardiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Author Contributions: Conception and design: R.J. Glynn, P.M. Ridker, J.E. Buring.
Analysis and interpretation of the data: R.J. Glynn, P.M. Ridker, S.Z. Goldhaber, J.E. Buring.
Drafting of the article: R.J. Glynn.
Critical revision of the article for important intellectual content: R.J. Glynn, P.M. Ridker, S.Z. Goldhaber, J.E. Buring.
Final approval of the article: R.J. Glynn, P.M. Ridker, S.Z. Goldhaber, J.E. Buring.
Provision of study materials or patients: J.E. Buring.
Statistical expertise: R.J. Glynn.
Obtaining of funding: R.J. Glynn, J.E. Buring.
Collection and assembly of data: R.J. Glynn, P.M. Ridker, J.E. Buring.
Glynn RJ, Ridker PM, Goldhaber SZ, Buring JE. Effect of Low-Dose Aspirin on the Occurrence of Venous Thromboembolism: A Randomized Trial. Ann Intern Med. 2007;147:525-533. doi: 10.7326/0003-4819-147-8-200710160-00004
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Published: Ann Intern Med. 2007;147(8):525-533.
Clinically significant venous thromboembolism (VTE) is an age-related condition that affects 1 to 2 of every 1000 adults per year (1–3). Surgery, trauma, immobilization, and cancer frequently trigger VTE, but between one third and one half of all first VTE events occur without these triggers (3–6).
Short-term aspirin therapy has some efficacy in preventing VTE in certain high-risk patients. A meta-analysis of 62 randomized trials in orthopedic surgical, general surgical, and high-risk medical patients found that a few weeks of antiplatelet therapy (usually with aspirin) reduced the risk for pulmonary embolism by about 67% and the risk for deep venous thrombosis by about 40% (7). Subsequently, the randomized Pulmonary Embolism Prevention trial (8) found a statistically significant 34% reduction overall in risk for VTE associated with short-term aspirin therapy in patients with hip fracture or elective arthroplasty. An updated meta-analysis, focused on patients at high risk for occlusive vascular events, found a statistically significant 25% reduction in the odds of pulmonary embolism associated with antiplatelet therapy (9). However, recent randomized trials indicate that therapy with low-molecular-weight heparin may be more effective than aspirin, and such treatments are preferred in current treatment guidelines (10, 11).
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